Containing Cost Despite the Cost

Making the CMS Payment Policy for Healthcare-Associated Infections Work: Organizational Factors That Matter

“…However, it offers important preliminary insight into the role played by organizational factors in helping to enhance the recognition, acceptance, and significance of the CMS policy as a QI driver within hospitals. These findings support the notion that organizational culture, leadership behaviors, and staff behavior matter as facilitators of CMS policy implementation, consistent with the preliminary conceptual model put forth in Stone et al (2010). The study findings also support the idea that there are additional factors which moderate how these organizational factors work to give voice and credibility to the CMS policy on an everyday basis.…”

“…A model adapted from Stone et al (2010) and derived from the interpretive analysis is seen in Figure 1. This diagram forms the basis for the remainder of the results discussion.…”

“…A qualitative approach using interviews was chosen to explore the two research questions comprising this part of the overall project. This method was chosen for two main reasons: (a) qualitative methods are ideally suited to examining the roles of organizational factors and context in facilitating policy implementation, as Stone et al (2010) and others (Shortell 1999) reinforce; and (b) the study is exploratory in nature, seeking to identify preliminary relationships rather than validating those relationships on a generalizable scale (Sofaer 1999). We conducted semi-structured, in-depth telephone interviews with lead infection preventionists from 36 non-federal, acute care hospitals in the United States.…”

“…Recently, a conceptual framework has been identified for pursuing important research questions around how the CMS policy might help produce changes in various quality and cost outcomes (see Stone et al 2010). This framework is applicable to examining the role of organizational context in shaping the extent to which the CMS policy is recognized, accepted and acted upon by hospital personnel.…”

Pharmaceutical Step-Therapy Interventions: A Critical Review of the Literature

“…33 No direct implications can be drawn from this research for the use of ST to address the broader use of antipsychotics in the commercially insured population given that rates of off-label use are high, 34 and commercially insured patients may be less vulnerable to the administration requirements of ST. As part of its comparative effectiveness research program, the Agency for Healthcare Research and Quality (AHRQ) concluded in 2007 that there was "insufficient high-grade evidence to reach conclusions about the efficacy" of atypical antipsychotics (olanzapine, quetiapine, risperidone, ziprasidone) for off-label uses such as behavioral problems in dementia, depression, obsessive-compulsive disorder, posttraumatic stress disorder, and personality disorders. 35 For PPIs and NSAIDs, the research indicates that ST, even without grandfathering, can reduce drug expenditures without increasing use of other related medical services, making these therapy classes low-hanging fruit for increased management for plan sponsors who have yet to implement ST.…”